title: Tuberculosis in healthcare workers and infection control measures at primary healthcare facilities in South Africa.
abstract: BACKGROUND
  Challenges exist regarding TB infection control and TB in hospital-based healthcare workers in South Africa. However, few studies report on TB in non-hospital based healthcare workers such as primary or community healthcare workers. Our objectives were to investigate the implementation of TB infection control measures at primary healthcare facilities, the smear positive TB incidence rate amongst primary healthcare workers and the association between TB infection control measures and all types of TB in healthcare workers.
  
  
  METHODS
  One hundred and thirty three primary healthcare facilities were visited in five provinces of South Africa in 2009. At each facility, a TB infection control audit and facility questionnaire were completed. The number of healthcare workers who had had TB during the past three years was obtained.
  
  
  RESULTS
  The standardised incidence ratio of smear positive TB in primary healthcare workers indicated an incidence rate of more than double that of the general population. In a univariable logistic regression, the infection control audit score was significantly associated with reported cases of TB in healthcare workers (OR=1.04, 95%CI 1.01-1.08, p=0.02) as was the number of staff (OR=3.78, 95%CI 1.77-8.08). In the multivariable analysis, the number of staff remained significantly associated with TB in healthcare workers (OR=3.33, 95%CI 1.37-8.08).
  
  
  CONCLUSIONS
  The high rate of TB in healthcare workers suggests a substantial nosocomial transmission risk, but the infection control audit tool which was used did not perform adequately as a measure of this risk. Infection control measures should be monitored by validated tools developed and tested locally. Different strategies, such as routine surveillance systems, could be used to evaluate the burden of TB in healthcare workers in order to calculate TB incidence, monitor trends and implement interventions to decrease occupational TB.
authors.affiliation: Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Parow, South Africa ; Department of Clinical Epidemiology, Biostatistics and Bio-informatics, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Mareli M
authors.initials: MM
authors.lastname: Claassens
authors.forename: Cari
authors.initials: C
authors.lastname: van Schalkwyk
authors.forename: Elizabeth
authors.initials: E
authors.lastname: du Toit
authors.forename: Eline
authors.initials: E
authors.lastname: Roest
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Lombard
authors.forename: Donald A
authors.initials: DA
authors.lastname: Enarson
authors.forename: Nulda
authors.initials: N
authors.lastname: Beyers
authors.forename: Martien W
authors.initials: MW
authors.lastname: Borgdorff
mesh_terms: D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission; D003430:Cross-Sectional Studies; D006268:Health Facilities; D006282:Health Personnel; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000592:standards*; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission